POS0952 THE IMPACT OF DIET ON DISEASE ACTIVITY IN SPONDYLOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW
Authors: A. Ortolan, M. Felicetti, M. Lorenzin, G. Cozzi, G. Striani, A. Doria, R. Ramonda
Journal: Annals of the Rheumatic Diseases (2022)

Background Diet is thought to have a role in inflammatory diseases development and course. However, at present, no recommendations can be given to spondyloarthritis (SpA) patients regarding a specific type of diet/dietary supplement, as evidence on the topic is sparse. Objectives To review the evidence about the effect of diet/dietary supplements on SpA disease activity Methods A systematic literature review (SLR) was conducted in MEDLINE and SCOPUS according to the “PEO” format (Population: SpA, axial or peripheral, including Psoriatic Arthritis-PsA; Exposure: any kind of diet/dietary supplement; Outcome: any available disease activity measurement). Inclusion criteria were: adult patients, Randomized Controlled Trials (RCTs) and longitudinal studies (so that a pre-and post-intervention assessment were available), papers in English. Risk of bias (RoB) was independently judged by 2 authors (AO, MF) and conducted with different tools according to the study design: Newcastle Ottawa Scale (NOS) for observational studies, the ROBINS-1 tool for non-randomized studies, and the Cochrane risk of Bias tool 2.0 for RCTs. Results Literature search yielded 286 publications. After exclusion of 59 duplicates, 171 titles/abstract, and 44 full-texts, we included 8 interventional and 3 observational studies (Table 1). Among the former, 2 RCTs, one at unclear and one at low RoB, failed to show benefit of probiotics in SpA. One RCT at unclear RoB showed that weight loss, but not hypocaloric diet, was associated to MDA achievement in PsA. The other RCT, as well as the 4 quasi-interventional studies, were at high/serious RoB respectively. Among the observational studies, one study on Mediterranean diet demonstrated an association of diet adherence and a&gt;=20% decrease of ASDAS in axSpA. Two other studies were judged of poor quality. Table 1. Characteristics of the included studies Author year Popula - tion Interven tion Study design Rando-mized Controlled Sample size Follow-up (weeks ) Primary outcome Male Sex (% ) Mean Age (years ) Concomitant medications besides symptomatics Experimental design Lassus 1990 PsA PU ethyl ester lipids supplementation Quasi-exp No No 80 8 NR 50 49 stable csDMARDs Appelboom 1994 AS Milk product deprivation Quasi-exp No Yes (AS vs RA) 25/10 6 NR NR NR 28% on stable csDMARDs Sundström 2006 AS Omega 3 fatty acids RCT Yes Yes (high vs low dose) 24 21 NR 61 NR No csDMARDs Di Minno 2014 Obese/ overweight PsA Hypocaloric diet RCT Yes Yes (hypocaloric vs free diet) 138 24 MDA (+) 36 45 All patients started anti-TNF; concomitant MTX in 29% Klinberg 2019 Obese PsA Hypocaloric diet Quasi-exp No No 46 12-16 MDA (+) 36 56 100% on stable cs/bDMARDs Klinberg 2020 Obese PsA Hypocaloric diet Quasi-exp No Yes (PsA vs controls) 74 20 NR 36 56 100% on stable cs/bDMARDs Brophy 2008 SpA Probiotics Internet- based RCT Yes Yes (probiotics vs placebo) 147 12 Satisfaction of CONSORT statement (+) 64 44 10% on stable b/csDMARDs Jenks K 2010 SpA Probiotics RCT Yes Yes (probiotics vs placebo) 63 12 BASFI (-) 63 43 28.5% on csDMARDs Observational Design Adawi 2018 PsA Intermittent fasting cohort - No 37 4 NR 37 43 100% on stable cs/bDMARDs Ben Nessib 2020 SpA Fasting-refeeding cohort - No 12 28 NR 45 47 40% on stable cs/ bDMARDs Ometto 2021 axSpA Mediterra-nean diet cohort - Yes (Mediterra-nean vs free diet) 161 24 NR 65 51 100% on stable cs/bDMARDs PsA: Psoriatic arthritis, AS ankylosing spondylitis, SpA spondyloarthritis, ax: axial; RA Rheumatoid Arthritis, PU polyunsaturated; RCT Randomized Controlled Trial; exp=experimemntal; MDA Minimal Disease Activity; CONSORT CONsolidated Standards of Reporting Trials; BASFI Bath Ankylosing Spondylitis Functional Index; (+) or (-) indicate whether the primary outcome of the study was met or not Conclusion weight loss seems to be able to impact disease activity in SpA, while probiotics were not effective in the available RCTs so far. Adherence to Mediterranean diet might play a role in reducing disease activity. Evidence for effectiveness of dietary behaviors in SpA is quite heterogeneous and high quality studies are warranted to better understand the role of diet in SpA. Disclosure of Interests Augusta Ortolan: None declared, Mara Felicetti: None declared, Mariagrazia Lorenzin: None declared, Giacomo Cozzi: None declared, Giovanni Striani: None declared, Andrea Doria Speakers bureau: Novartis, AbbVie, Pfizer, MSD, Janssen, GSK, Consultant of: Novartis, AbbVie, Pfizer, MSD, Janssen, GSK, Roberta Ramonda Speakers bureau: honoraria and speaker fees from Novartis, AbbVie, Pfizer, MSD, Janssen, Consultant of: Novartis, AbbVie, Pfizer, MSD, Janssen